Confused about setons

[xX_LittleMissValentine_Xx]

Hello!
I have just been reading around doing a bit of research. And I'm confused! I found a Crohn's and colitis uk information sheet about fistulas and I don't understand what a seton is like.
This is the information sheet if anyone is interested: http://www.nacc.org.uk/downloads/factsheets/Fistula.pdf
Anyway, are there different types of setons depending on the fistula?
How does it make it heal?
Thanks for any answers!

 

[lotte26]

Hey there! I have had a few setons before, they are basically a rubber band that goes through your fistula and through your bottom, so it is basically there to drain the muck and ... Crap... Out I guess. On my first seton my fistula was a Y shape so they had to make it into two holes (one in one out), so they cut the meat between the two exit holes and inserted a seton. I then had to wait for that to heal, and I then had the seton removed, and a fistula plug inserted, which your skin grows in to. You may not have been told of this option? It's quite costly here in new Zealand but luckily my dad coaxed the insurance people in to paying for half of it.. It did work for me at first but I have very active disease and many more fistulas returned. I didn't want to live with getting all these surgeries forever so I decided to be done with my bum and some guts so I got a permanent stoma. Now i just have to deal with other problems! Anyway setons are fine and dont/very rarely hurt, it's just like having a rubber band out your bum ! Hehe. Good luck!

 

[xX_LittleMissValentine_Xx]

Does it feel uncomfortable?
Also, I'm assuming that is for perianal fistulas, what if it is a different kind?
I have one (I'm not sure where it starts inside) which comes out at the skin fairly near the top of my bum, I would say that is possibly a few inches away from my anus.
The more I am learning about fistulas the worse I am realising mine are
I was thinking a couple more ops and I would feel so much better, maybe it is going to be a longer journey than I originally thought.

 

[KWalker]

Oh no! That's my fear that my abscess could turn into a fistula. I'm sorry I hope things work out for you and don't cause much pain

 

[xX_LittleMissValentine_Xx]

My recent abscess hasn't turned into a fistula... yet! But I have complex fistula which has been around for a while and they have only just taken me seriously about it really.
I don't have a consultation for a while so I don't know what the plan will be so I've just been doing my own research really.

 

[Mark63]

Hi,

I wish there was a simple answer to your original question. The NACC fact sheet is a good starting place. There are many variations with how setons are used. Some are the cutting variety, some just for drainage. Some are like rubber bands others are braided surgical silk. Some are used just short term to provide drainage and then removed once things have quietened down in the hope that things will seal themselves. This is often accompanied by antibiotics and/or one of the anti TNF drugs. Some are left in place on a semi-permanent basis like mine, that has been in place for last five years or so. There are no plans to remove it. Long term setons are changed once in a while.

In a lot of cases the draining setons causes little or no pain once the initial surgery has settled. Cutting setons seem to be more painful, particularly when they get tightened. Some draining setons migrate out of the fistula tract into good tissue, this can be a cause of pain and allow infection to build-up.

Everyone is different!

Hope this has been of some help.

Mark

 

[bigtruck]

Hi little miss v I have a lot of fistula tracts in the tail end and have had setons in the past. With crohns the treatment for fistula is very conservative as if you go in cutting them out you very often end up with a gaping wound that won't heal, this is why drainage setons and anti biotics are the mainstay treatment. Another concern is how high up the anal canal the fistula is and whether it runs through the sphincter muscle as cutting through it can cause problems with incontinence. In my case I've ended up with a loop colostomy to try and stop "feeding" the sepsis which was caused by my peri anal disease.

 

[xX_LittleMissValentine_Xx]

I think one of the tracts does go through the sphincter which worries me
I really don't want to have a colostomy (I know if it had to happen I would deal with it) But right now I'm sticking with not wanting one!
Thanks for the help everyone, I guess I will have to wait and see what happens. This is all fairly early days for me at the moment.

 

[lotte26]

Hey! My Fistulas were perianal and always very close to my va-jayjay. Then my last one was actually in my vagina and my crohns was the worst it had ever been so I was going to need a resection as well, and my large intestine was mostly damaged so we decided to go for a colostomy, but that is definitely a choice I made, as I had had it with having pain during intercourse, and feeling so gross down there. Plus my butt hole constantly felt like a war zone! I would imagine it wouldn't be as much an interference with stuff (sexual) like that if it's by your anus, and Fistulas can be manageable! Oh and setons aren't really uncomfortable, sometimes they may feel a bit weird but you just have to readjust your position a bit. Anyway I really didn't want to freak you out or anything! I feel for you! Fistulas are a pain in the ass!

 

[Cookie]

I have seen numerous posts lately where people are saying that they are afraid their absceses will turn into fistulas and this confuses me. The last thing I want to do is provide anybody with false information, so I'd like to get others' opinions on the subject.

I have dealt with both fistulas and abscesses. It has always been my understanding that if you have an abscess, the goal is to get it to drain so that it does not become infected and result in sepsis. Many doctors actually lance abscesses to make them fistulas to allow for them to drain, which is actually what a seton does. That is why I am not understanding the comments about not wanting an abscess to become a fistula (I have seen it said on several other threads).

Please don't take this post the wrong way...I am not trying to be a smart a$$. I am actually confused and want to know what others have to say on the subject.

 

[xX_LittleMissValentine_Xx]

Cookie - My understanding of my abscess now, is that is it in the tissue in my bum somewhere near the rectum, but not inside it. They then did make a hole out to the skin to drain it (so kind of like a fistula). But if the abscess builds up again and causes further damage, then a fistula could develop in the other direction into the rectum, causing a fistula from the rectum to the skin. This is what we don't want to happen as I would then probably need a seton. We are hoping that the hole which the abscess (and the surgeons) have made will heal it up.
Charlotte - Thanks. You haven't freaked me out it is good to hear people's experience to get a realistic idea. I can imagine how horrible it must be having a fistula into your vagina. I don't have a boyfriend at the moment so don't have to deal with the sexual stuff (thank god) but all this is causing me worry in that department! Everything is just all so close together around there and I can't imagine wanting anyone to be around that area! (Which is kind of ironic as I have had more people than ever poking around in the last month! )

 

[Cookie]

Thanks for clarifying that. I had a fistula tract from rectum to vagina with a "sideshoot" that is where the abscess would always form, so it was important for that pathway between the abscess and the fistula to remain open to allow for drainage. Maybe that's why I was confused. I guess I thought that all abscesses were directly connected to the rectum or other part of the GI tract. Thanks again for setting the record straight.

 

[MikeinBklyn]

Having been there I can only offer my observations. My fistula was thru the sphincter and exited about 1½" from the anus in a straight line up the crack. I had two surgeries, lay open the tract and let it heal. The seton was a rubber cord that was tied at the end. My main beef with the seton was where the knot tying it together would irritate the area causing discomfort. Of course the tract itself was uncomfortable. I was put on Humira which did a great job in closing the fistula, but after 10 days (14 day cycle) it would open again.
After upping the Humira dosage to every 10 days the fistula has been closed for 14 months and I feel great.

The antibiotics did a job on me. Flagyl is horrible....period. And Cipro was nice enough to kill off all the good bacteria in my gut causing a C. Diff infection in the colon, not pleasant.

Please watch those antibiotics as they can be harmfull if taken for a long time, over 6 months.

I found that it was paramount to keep the area as clean as possible, this helped greatly with irritation. Sitz bath every few hours helped a lot.

Fistulas suck.

I wish everyone the best of luck!

 

[xX_LittleMissValentine_Xx]

Thanks Mike.
Its good to hear things are going well for you! I know its not a nice journey but hopefully one you are at the end of! So have you had your seton removed now? And did you have any problems with incontinence?
Thanks again

 

[IAmTheWalrus]

Had two setons in at once, they were really sore for about a week, but after that I forgot they were even there, haha. When going to the loo, they move or push out of the way, so you don't have to worry about messing it up, also, it does take a little while to get used to "wiping", but like I said, after a while, you will forget they were there, when I was told that I was having mine removed I was like, "ah really? I can't even feel them and it's stopping me from getting another abscess!?", so I got operated on and had to have the area packed every day for a month and then a few months later I started Humira for the two peri anal fistula's.

All of my procedures were done in out patient, so you wont have to stay in hospital.

 

[DustyKat]

Hey Cookie,

LMV is right about fistulas and abscesses. You can have a fistula without an abscess and you can have an abscess without a fistula or you can have both.

A fistula is a passage between two surfaces or organs. So in perianal disease it may be from bowel to skin or bowel to vagina and so on. An abscess is a pocket of pus and when they lance or open it up what they are really doing is creating a sinus or blind (dead end) tract that allows the abscess to drain.

Dusty. xxx

 

[Cookie]

Hey Cookie,

LMV is right about fistulas and abscesses. You can have a fistula without an abscess and you can have an abscess without a fistula or you can have both.

A fistula is a passage between two surfaces or organs. So in perianal disease it may be from bowel to skin or bowel to vagina and so on. An abscess is a pocket of pus and when they lance or open it up what they are really doing is creating a sinus or blind (dead end) tract that allows the abscess to drain.

Dusty. xxx

So abscesses can be pockets of pus that are not connected to the bowel? Otherwise, when they lance it open, are they not creating a fistula? I guess that was my confussion, I always thought that abscesses were connected, but from what I think you are both saying is that they are not (but can be), right?

 

[DustyKat]

Yes, abscesses can exist on their own, not connected to anything OR they can be part of fistula.

When they lance them they are not creating a fistula as a fistula is an opening between two areas. Lancing an abscess means only one end is open.

Dusty. xxx

 

[MikeinBklyn]

LMV......I had the seton removed a week after upping the dosage of Humira to every ten days. The fistula closed in two days! Thankfully there was no problem with incontinance. My CR doc was very conservative, although I did have a fistulotomy twice, laying open of the tract.

I wish you much luck.

 

[xX_LittleMissValentine_Xx]

Thanks, its really encouraging to hear some success stories!

 

[ehs8998]

Hi there,
My daughter who is 10 had 3 abcesses, which they drained, and then she takes Humira. The last one they decided to put in a seton, and she has had it for almost 3 months now. They come in different colors, evidently, and are for a couple of different reasons. The one she has, is to keep the fistula open and keep another abscess from developing. Basically her doctor says he is buying her some time and seeing if we can put off more surgeries until she is older... she rarely notices it, and does anything she wants to.. swims, plays sports, runs, etc. she is also on Humira 1x a week, and some antibiotics daily.. and to me, if she can keep the seton in forever it would be fine.. just an opinion from a mom...

 

[ontariomom]

I had a large abscess which started to heal after being lanced and many many many rounds of antibiotics. But then for what ever reason, it started to pain me again and i ended up with a fistula. I have a complex fistuala which the surgeon described as hill shaped and goes behind many schphinter muscles. Their concern of course if they go in and surgically close it they will ahve to cut too many muscles and there fore leave me incontinent. NOT something i really want. I have had the seton in for almost a year(june) It rarely bothers me. Most days I dont even know its there. Sex isnt really an issue . It sticks out right next to my anus. I also have another fistula in my other cheek, also next to my anus ....so i have one on each side. The second one does not have a seton in. They do weep on occassion but i have found antibiotics donnt make a difference anymore so i no longer put my b ody through that anymore. Lots of heat helps more then anything.

I would rather keep the seton in forever then have to face surgery. My biggest fear about surgery is getting packed. I couldnt handle the pain last time. I dont want to handle it again. Its weird. I can handle pain that comes from my body, but i cant handle pain that is from someone doing soemthing to me.....does that make sense???

Good luck to everyone with their abscesses and fistulas......its not a fun thing